: Psychosis A. Kurland etal.: LSD in the Treatmentof Alcoholic, 85

and that Literature

n surveys ! Angrlst, B, M., S. Gelshon: The phenomenology of _ Mode¢, K, E,, R. H. Rech: Antagofliam by mona-to whom experimentally induced amphetamine psychosis -pre- amine o_¢ldase inhibitor* of a.methyltyroslne-indueed

limlnary observations. Biol, Psychlat. $ (1970). 95-I07 ¢atecholamine depletion and behavioral depression.[d not be 2 Angrist, B. M.. ]. _q', $chweitzer, A, ]. Yriedhol[, J. Ph_rmacol. exp. Ther. 156 (1967), ?0-75

to vohm- s. Gershon: Investigation of p.methoxyamphetamine 9 Rutledge, C, 0., N. Welner; The effect ot reserpineexcretion in amphetamine induced psychosis. Nature upon the synthesis of norepinephrine in the isolated

ay for its 223 (1970), 651-652 rabbit heart, J. Pharmacol, exp. Thee. 157 (1967).

ich would s Angrist, B. At., ]. W. Schweitzer, A. ], Friedhof[, 290.302S. Gershon, L, J. Hekimian, A. Floyd: The clinical 10 $chweitzer, ]. W,, A. ]. friedhoH: Amphetamines

hetamine symptomatology of amphetamine psychosis and its in human urine: rapid estimation by gas-liquid

mode of relationship to amphetamine levels in urine. Int. chromatography, Clin, Chore• (1970} in pressPharmacopsychiat. 2 (1969), 125-139 11 Schweit:er, ]. W., A. ], Fried/tolL B. M. Angrlst,

ae is de- 4 F,txe, K., U. Unger_tedt: I'Iistochemical, biochemical S. Gershon: The excretion of p-methoxyamphetamine

nchanged and functional studies on central monoamlne neu- administered to humans. Nature (1970)in presstons after acute and chronic amphetamine administra- 12 Shulgln, A. T., T. Sargent, C. Naranjo: Structure-

degraded tion. In: International Symposium on Amphetamines activity relationships of one-rln_ psychotomimetles.and Related Compounds. ed. by Costa, E., S. Carat- Nature 221 (1969), 537-541

letaiTtin.e, tlni. Raven Press, New York 1970 13 Smythies, ]. R., V. S. ]ohnston, R, ]. Bradley, F.5 Same as above• Pages 272-273 Bcnington, R. D. Morin, L. C. Clark, jr.: Some new

S appear- 6 Fuxe, K., U. Ungerstedt: I'tistochemieal studies on behavior-disrupting amphetamines and their signifi-

, ranging the effect of (+)-amphetamine, drugs of the imipra- caner. Nature '2_16(t967). 128-129

am at the mine group and tryptamine on central catecholamlne 14 Stein, L.: Psychopharmaco]oglcal substrates o[ mentaland 5-hydroxytryptamine neurons after intraventri- depression. In: Antidepressant Drugs, ed, by Garne-

t at least ¢ular iujeetintt of catecholamlnes and 5-hydrnxy- tiai, S., M. N. G. Dukes. Excerpta Med, (Arose.} 1066_ryptamine. Europ. J. Pharmacol. 4 (1968), 133-140 15 Welch, B. L.. A. S. Weldz: Stimulus-dependent anta-

catechol- 7 GriHith, ]. J., ]. Oases, J. Cavanaugh: Paranoid gonism of the ct-methyltyrosine-induced lowering ofhetamine episodes induced by drugs. J. Amer. reed. Ass. 205 brain catecholamines by (+)-amphetamine in intact

(1968), 39-45 mice. J. Pharm. Pharmacol. 19 (1967), 841-843be pro-

Des. A. ]. Friedho[f, ]. W. Schweitzer. New York University. School o[ Medicine,New York (N.Y.) U.S.A.

Pharaakoptychiat._4, 83-9'_(1971}. LSD2129!

gas dare- LSD in the Treatment of Alcoholics*itive and

material.

:stimated. A. Kurland t, C. Savage-_ W- N. Pahnke '_, S. Grof 4, J. E. Olsson s

,hetamine

t Superintendent, Maryland State Psychlatric Research Centera between = Associate Superintende:_t, Maryland State Psychiatric Research Centergextreme s Director, Clinical Sciences Research, Maryland State Psychiatric Research Center

amphet- s Chief, Psychiatric Research, Maryland State Psychiatric Research Center

• amplxet- s Chief, Psychological Research, Friends of Psychiatric Research, Inc,

Introduction

The early LSD research of Osmond and Hoffer in the treatment of alcoholism waslafifin im based on their idea that the psychotomimetic properties of LSD could produce e_antitative delirium tremens-like state. It was hoped that such a state might have a favorable[ra6glich. effect on the patient's drinking in a similar way as has been known for naturallyschiedene occurring D.T.'s. Although their early hope was not substantiated, they found thatter durda

rollierten some of their patients who had positive experiences with LSD did well thereafter.zwischen In a paper read to the New York Academy of Science in 1956, entitled, "A Review ofwurden the Clinical Effects of Psychotomimetic Agents," Osmond (13) proposed the hypothesis

mg m6g- that a single overwhelming transcendental experience with psychedelic drugs mightiren. Die

und der * Paper presented at the 7th International Congress, CINP, Prague, Czedaoslovakia, August11-15, 1970.

?

84 A. Kurland, C. Savage, W. N. Pahnke, S. Grof, J. E. Olsson1

be beneficial to alcoholics. Within a relatively short time, Osmond's suggestion led !to clinical studies seeking to verify this hypothesis 1. Uncontrolled studies carried i

out by Smith (20) and Chwelos (3) yielded favorable impressions which subsequently _led to controlled trials on alcoholic patients.

;.. In these studies, different treatment techniques were employed. Smart el a]. (19), iJohnson (9), and Hollister et al. (8) utilized a treatment method that is perhaps best Idescribed as psychedelic chemotherapy, in which the major emphasis was on theadministration of the drug itself. The amount of psychotherapy in the preparation forthe session and in the post-treatment period was minimal. In a modification of this 2approach, Ludwig et al. (12) added hypnotic induction during the very limited pre-

paration for the session and in the session itself. These studies have yielded essentiallysimilar findings, namely, that the results of LSD therapy in this treatment contextwere not significantly different from those obtained in the control groups. _

In the present study, psychedelic-peak therapy has been used; a treatment technique

distinctly different from those described above. One of its basic characteristics and "_immediate goals in the drug session itself is the achievement of a peak or transcendental ÷experience, but just as important is the intensive psychotherapy which occurs in the weeks !prior to the psychedelic drug session and the follow-up therapy in the weeks after tohelp with the work of integration. The method of facilitating this experience has been t,described in detail elsewhere (see Schlien et al., 18; Kurland et al., 10, and Pahnke th

_./_.!:._i_iiii,.___ et al., 15). The preparation for the drug session involves an average of about twenty

.......__;( hours of intensive psychotherapy. During this period, the therapist aims at establishingdose rapport with the patient and gaining intimate knowledge of the patient's devel- o_....._ opmental history, dynamics, defenses, and difficulties. In specific preparation for the ir

session itself, the patient is acquainted with the basic effects of the drug and encouraged::-.: to trust the therapist, himself, and the situation. This is a very important part of the

preparation that enables the patient to utilize the session in the optimal way - to let go sevoluntarily of his usual ego controls and so be completely open to whatever experi- o_ences he encounters, n

LThe experimental drug sessions themselves, are carried out in a special treatment

suite, furnished like a comfortable living room, with sofa, easy chairs, rugs, drapes, cpictures, flowers, and high-fidelity music equipment. The patient's therapist and apsychiatric nurse are in constant attendance throughout the period of drug action a

I (10-12 hours). For most of the session, the patient reclines on the sofa with eyeshadesmad stereophonic earphones, alternately listening to carefully selected classical music or

I interactingwiththetherapist._'_i!?_i>_E The experiences that the patients have under these circumstances cover a wide range t-

• " E from aesthetic visions and sensations, through reliving of traumatic life experienceso_ il with a powerful abreactlon and catharsis to psychedehc peak reactions. The psychedehc' peak experience has been found most useful from a therapeutic point o view and the

_:_ i The single overwhelming experience has sometimes been referred to as transcendental" ._ ,, . l:_

"i_2_ by Holier & Savage (7 17), "psychedelic by Kurland et al. (10), and psychedelic peak. experience by Pahnke et al. (15).

LSD in the Treatment of Alcoholics 85

m led preparation, as well as the set and setting is specifically structured in order to facilitatearried its occurrence. One of the major goals of the therapist during the session is to help the

uently patient to stabilize the experience on this level.

The basic characteristics of the psychedelic experience have been described by

• (19), Pahnke (14):

_sbest 1. Sense of unity or oneness (positive ego transcendence, loss of usual sense of selfm the without loss of consciousness).

on for 2. Transcendence of time and space,

ff this 3. Deeply felt positive mood (joy, peace, and love).

] pre- 4. Sense of awesomeness, reverence, and wonder.atiallyontext 5. Meaningfulness of psychological and/or philosophical insight.

6. IneffabiIity (sense of difficulty in communicating the experience by verbal description).

mique:s and Methodology of the Present Study

dental In this double-blind controlled study, 135 alcoholic patients admitted to the Alcoholicweeks Rehabilitation Unit of Spring Grove State Hospital, were randomly assigned either to[ter tos been a high-dose treatment group (450 mcg) or a low-dose control group (50 mcg), on a

two-to-one basis (90 high dose vs. 45 low dose). All patients were treated alike during'ahnhethe preparation since the therapist did not know to which group the patient belonged.

:wentyfishing Analysis showed that the high-dose group averaged 21.6 hours of therapy (exclusivedevel- of the LSD session itself), while the low-dose averaged 20.0 hours. The length of time

in treatment from first to last therapy appointment was similar; the high-dose group!or the

araged averaged 7.3 weeks in treatment and the low-dose group averaged 6.7 weeks.of the Despite randomization, the high and low-dose groups were significantly different on

let go several important variables. In the high-dose group, 47.7% were married, 20% single_xperi- or widowed, and 330/0 separated or divorced, while in the low-dose group, 360/0 were

married, 40/0 single, and 600/0 divorced or separated. The low-dose group also had a

ttment large percentage of patients with five or more admissions - 18% as opposed to 3%of the high-dose group. 520/0 of the high-dose group had completed high school as

lrapes,and a compared to 360/0 of the low-dose group. Randomization, however, achieved matching

action on IQ, age, occupational status, and most importantly, on the pre-treatment rating ofabstinence.

shades

usic or Results

A comprehensive psychological test battery including performance and intelligence'.rangeriences tests, projective techniques, and personality inventories was administered just prior to_edelic acceptance into the program and one week after the LSD session. A more limitednd the battery of tests was given at the six, twelve, and eighteen month follow-up points.

While the great majority of these psychological test results indicated significant im-dental" provement in both treatment groups from pre- to post-treatment, the high-dose groupic peak

showed no significantly greater improvement over the low-dose group on any test

6 Pharraakopsy'chlat. 2/71

,_ _ "_'=_,._'_w_" "_?- L,,:_,__,_ v' _¢_'_: _ :_ '*,_ "_ _-_ • "_'_'_, _ _-¢_'"_ _,_-:'*_"_" _" _*_-_,_'_,'.L _,_",':' f" '_ ,_'_._._,'_,_._-_--'_',' " , ....

_ _ . N. Pahnke, S. Gro[, ]. E. Olsson

:i_i_., 90- ----MalePre variables wzthm"" one week of the LSD((_i !_" ----_t session. As an illustration, Figs. land2

_:!i_ 8_ .... ._ , showthe pre- and post-MMPIcom-":!i_ 75- positeprofilesfor the low-andhigh-

70---

_ _ 65" dosegroupsrespechvely,whileFig.3

60- .1_ _ profiles of both groups. Both groups-;i/; "_ compares the adjusted post-treatment

55-\ show much improvement, particularly

- _ in the Depression(D) and Psych-

asthenia (Pt) scales,but the high-dose

0 group shows no clear superiority ink F KHs DHyPdMfPaPfScMaSi A R

degree of improvement over the low-MMPI scales

dose group.Fig. 1 Composite Pre and Post-Treatment MMPIProfiles for 38 Low Dose Patients. Other personality inventories, such

as the Personal Orientation Inventory

90- Male [90 (POI),the Psychiatric Evaluation Pro--- Pre [-85

80-85_ Post / file (PEP), and the EysenckPersonality[80 Inventory (EPI) showed similar find-

75- . , F7570---_70 ings. Measures of intelligence and

_, 65- I _i_--, "_" "_t. [65 perceptual-motor performance (in-I eluding the Benton Visual Retention

_-55- A_. f \ [55 Test, Wechsler Adult Intelligence50- __50 _lt Scale, Raven Progressive Matrices and

_45 Imbedded Figures) showed significant

4_!, _40 improvement on some variables within0 _--_ both treatment groups, but again noL F K HsDHyPOMfPaPtScMaSi A R

MMPI scales significant differences were found be-

Fig. 2 Composite Pre and Post-Treatment MMPI tween high- and low-dose treatment

i!_11 Profiles for 81 High Dose Patients. groups. It is important to note that no :patients showed decrement in per-g0- Male -90 formance onlQ or evidence of organic85- ---" Lowdose -85

Highdose damage pre- to post-treatment.80- _80

1 75 q5 The results for three other tests,

70- _ -70 Holtzman Inkblot Test (HIT), Rotter

65- i65 Sentence Completion Test and Human

60- _. I60 Figure Drawings, whichcan be con-,--55- y'_, 55 sidered primarily projective in nature

50 _._ t50 "_ also showed no significant differences

_*._ 45 45 " between the high and low-dose groups.

40 40 However, both high and low-dose0 . : O,

L F Hs D Hy PdMfPaPtScMaSi A R groups showed a large, significantMMPI scales reduction in maladjustment as meas-

ured by the Rotter Sentence Com-Fig. 3 Composite Post-Treatment Adjusted MMPIJ Profilesfor Highand LowDosePatients. pletion Test.

LSD in the Treatment of Alcoholics 87

LeLSD

1 and 2!

I corn- _ ._t high- _ o -_ _":Fig.3 | I E "_

atment k I _

I

groups _ _ I ocularly _"_, I - _ __oPsych- _ _'o_ _ ol _ g <

;h-dose _o _ [ $ - : -_"_

,rity in / I _, "_ oae low- I _'0 %

,o

es,such __ "x ox _

ventory "__'- 8

on Pro- _ _ _";onality _ _ 7 _ _:

arfind- _ _. _o _' ,o' _, ._ _' " _' ¢,_- _ z _ Ece and a_uau!_sqe sfu!_J ueow fiupluupce (in- le_o.t palo.n,uoaurt:tention

lligenceicesand -_,:nificant : x o _ ,_s within i _ t -- -_

gain no _ t

und be- _ g. I _eatment _, e | - g _ <:that no i g _ _, x _ _. _'

in per- i _'g,o_v _ t_, -,_ _ o_

organic l I" \ I _' tI l _ *_ :_'_

er tests, x o - % E}, Rotter _ Xx _\.Human \ xx - _

be con- xx _ _ .:n .nature Xx = -= _ _

X 0 o..Y: _ .

_ferences _ _. _ __ ,_ _ ._ _, _, ._ o

_.groups. _uauJpn[pe sfuB_Jueow ),u_uJlsn[peow-dose lem!ldO jood ,_Jo h

gnificantas meas-:e Corn-

100-

90_ lO0-

Highdosegroup b_--- Lowdosegroup 90-80_,p<.05

Highdosegroup80..... Lowdosegroup

70- _ P< - 05

o_ 70- ._

8 60- ^

"-- _. 0 _ _*

"5 40

30 . 301 /,

/I"" 20_ /,," C3

f #

10- 1

: 0 C)

Pre 6 '_ 12 _ Pre 6* 12 18treatment (N=114) (N=g4) (N=gI) treatment (N-114) (N-94) rN-gl)(N=114} Monthsafter LSD _N=1141 Monthsafter LSD

Fig. 6 Percentage of Alcoholic patients essen- Fig. 7 Percentage of Alcoholic patients Essen-tially Rehabilitated After LSD Treatment: tially Rehabilitated After LSD Treatment:

Global Adjustment. Drinking Behavior.

ogischer LSD in the Treatment of Alcoholics 89

Final analyse s of psychological test results at six and twelve-mo_aths follow-up andnnenton preliminary statistics at eighteen months are consistent with the above findings fromilogie, the immediate post-session period in that there were no significant differences between

high and low treatment groups.28Tabellen Follow-up interviews and ratings of adjustment are now completed at the six-) month, twelve-month, and eighteen-month checkpoints for a total of 121 of the 135

alcoholic patients who were treated with psychedelic psychotherapy. While the studydesign made it possible for the patients to have up to three sessions, the vast majorityin both experimental and control groups (total of 117 patients) received only onetreatment with LSD. The 18 patients who had more than one LSD session were notfound to be different from the other I 17 in psychological and social measures based onpre-treatment testing, but as a group they received more average hours of treatment.Therefore, in the interests of uniformity concerning amount of treatment, results were

analyzed separately for the 117 patients who had only one LSD session (either a high orL " alow dose).

The percentage of these patients found and interviewed at the six-month follow-uppoint was 89% (104 out of 117 treated cases). Although the percentages dropped somewhatat the twelve and eighteen-month follow-up points to 80% and 78% respectively, thisis considered a very good follow-up rate, realizing that many alcoholics are difficultto keep track of in the community.

it der Frage The follow-up ratings of adjustment were made by an independent team of social

n Zentral- workers. Ratings were made on each patient on a predetermined 0 to 10 behavior ratingzusammen- scale. The Global Adjustment rating included occupational, interpersonal, and residen-die in den tial factors as well as the patient's use of alcohol, with a score of zero indicating poorestVer6ffent- adjustment and ten indicating superior adjustment. Zero on the scale measuring Drink-

sultate der ing Behavior indicated daily alcohol consumption, and ten indicated total abstinence.

rese. Sie ist Mean ratings of Global Adjustment and Drinking Behavior for the high and low-dosemehr tech- groups at the pre-treatment and six, twelve, and eighteen-nmnth foll0w-up points areausfiihrlid_ shown in Table 1.

in die Lage As shown, the high-dose group shows consistently higher mean ratings than the low-llen Bedin- dose group at all follow-up periods. However, mean change scores (post-minus pre-

ich selbst in means) do not show as large differences between the two treatment groups. In fact, whenthe data were submitted to analysis of covariance which takes pre-level into considera-zweite Telltion, 6 months after LSD was the only time that Drinking Behavior and Global Ad-

n die Wit- justment showed a significant difference between the high and low-dose groups'reur°m°du- (p <0.025 and 0.0S respectively - one-tailed test). The magnitude of difference in_hwid_tigen Drinking Behavior mean scores between the groups at 6 months is 1.4 and the differ-

!terfunktion ence in Global Adjustment is 0.50. At 12 and 18-months, this statistical advantage ofozoie Bezie- the high-dose group has disappeared, and there is virtually no difference between the

'rund Reiz- two groups in mean change scores. Apparently the significant, but small advantage ofie_lich wet- the high-dose treatment holds for only six months.

Ergebnisse The percentage of patients functioning in an "essentially rehabilitated" fashion is

:h Wirkung shown for the various groups in Table 2. A score of 8 or more on the 0 to 10 scale was

"rvensystem considered a rigorous criterion, indicating for Global Adjustment that a patient wasrliiutert, making "good attainment or adjustment" with regard to drinking, occupation, inter-

't

90 A. Kurland, C. Savage, W. N. Pahnke, 8. Gro[, ]. E. Olsson [ _

personal relations, etc. A score of 8 on the Drinking Behavior scale indicated some, but le,:only minimal, departure from total abstinence. Statistical analysis revealed that there aftwere significant differences between the high and low-dose groups in percentage of t sealpatients reaching this criterion, both in Global Adjustment and in Drinking Behavior, arebutagain,onlyatthe6-monthfollow-up, pat

In regard to the most important target symptom, Drinking Behavior, Table 2 reveals upthat at six months after LSD, 530/o of the high-dose group are greatly improved as patopposed to 33O/oof the low-dose group. By chi square this is significant at the 0.05 unf

groTable I Global adjustment: Means of high and low-dose groups before and after LSDtreatment.

Mos.After Before After TaLTreatment Treatment Treatment Change F p* Mo_

Pos "

High Dose (N =64) 450 Meg 4.16 6.52 +2.36Low Dose (N = 40) 50Meg 3.28 5.13 +1.85 Per,SixDiff.inChangeScores Pati(High Minus Low Dose Group) +0.51 3.76 0.05

Hi_.-!High Dose iN =59) 450 Meg 4.27 6.68 +2.41 (45('Low Dose (N =35) 50Meg 3.54 5.83 +2.29 t Lo_vTwelveDiff.inChangeScores (50(High Minus Low Dose Group) +0.12 0.95 N.S. X..

p (or,High Dose iN =57) 450 Meg 4.44 7.05 +2.61Low Dose (N = 34) 50Meg 3.47 5.97 +2.50 High

Eighteen Diff. in Change Scores (450 '(High Minus Low Dose Group) +0.I1 2.10 N.S. Low

f5o_* By analysis of covarianee (one-tailed test). X_.

p (oreTable 2 Drinking behavior: Means of high and low-dose groups before and after LSD treatment.

*SMos.After Before AfterTreatment Treatment Treatment Change F p'* ]

h,

High Dose iN = 64)450 Meg 2.83 7.02 +4.19 LSDLowDose (N = 40) 50 Meg 2.93 5.75 +2.82 of _"SixDiff.inChangeScores Furt:(High Minus Low Dose Group) +2.23 4.43 0.025 Thee

High Dose (N = 59)450 Mcg 2.88 6.66 +3.78 incr,.Low Dose (N =35) 50Mcg 3.00 6.37 +3.37 {TwelveDiff. in Change Scores(High Minus Low Dose Group) +0.41 0.24 N.S. T|

High Dose (N = 57) 450 Meg 2.95 6.77 +3.82 groui

Eighteen LowDose (N =34) 50 Mcg 2.97 6.38 +3.41 I low-_Diff. in Change Scores diffv(High Minus Low Dose Group) +0.41 0.32 N.S. to sa"

* By analysis of covariance (one-tailed test), the f:

LSD in the Treatment of Alcoholics 91

e, but level (one-tailed test). This significant advantage does not obtain at 12 and 18 monthsthere : after LSD. At 12 months, 470/0 of the high-dose patients are greatly improved as oppo-

tge of i sed to 480/0 of the low-dose patients, and at 18 months, 54°/0 of the high,dose patients

avior, i are so rated as opposed to 47O/o of the low-dose patients. The change in percentage ofpatients "greatly improved" in the high and low-dose groups from the six-month follow-

eveals , up point to the 12 and 18-month points is in part due to the decrease in the number of

red as patients found at these latter points. However, other calculations carried out taking thee 0.05 unfound cases into consideration also indicated that the advantage of the high-dose

group occurs only at the six-month follow-up point.:tment.

Table 3 Percentage of alcoholic patients essentially rehabilitated after LSD treatmenC.

P* Months Six Twelve EighteenPost-session

Percentage ofPatients Followed 89% (104/117) 80°/0 (94/117) 78% (91/117)

9.0_High Dose Group(450Meg) 44% (28/64) 46% (27/59) 53% (30/57)

Low Dose Group Global(50Mcg) 25% (10/40) 34% (12/35) 41% (14/34) Adjustment

_.S. X., 2.97 0.77 0.71

p (one-tailed) 0.05 N.S. N.S.

I High Dose Group(450Meg) 53% (34/64) 47% (28/59) 54% (31/57)

i Low Dose Group Drinking_.S. i (50Mcg) 33% (13/40) 48% (17/35) 47% (16/34) Behavior

X_ 3.44 0.012 0.21

p (one-tailed) 0.05 N.S. N.S.ttment.

! * Scores of 8, 9, or I0 on a 0-10 Rating Scale.p*

In speaking to questions which might be raised concerning the harmful effects of' LSD administration, only one adverse reaction has been observed in our entire series

, of well over 200 alcoholics treated with either high or low dose to date (June 1970).Furthermore, even in this one case, the reaction was reversed by conventional therapy.

_.0_5 These observations would tend to indicate that the risk of therapy is not substantiallyincreased by the addition of a high dose.

Discussion

_.S.The main finding of a difference at six months follow-up of 530/0 of the high-dose

group essentially rehabilitated in regard to drinking behavior as opposed to 33o/0 in the

low-dose group is on the face of it quite substantial. However, the significance of thisdifference is at the 0.05 level, and from a more rigorous point of view, we would have

S.S. to say that a higher level of confidence would be more convincing. Also, we must facethe fact that randomization failed to match the two groups on such variables as marital

92 A. Kurland, C. Savage, W. N. Pahnhe, S. Gro[, ]. E. Olsson

status and previous admissions, although they were matched on IQ, age, occupational

status and pre-treatment abstinence. This failure of randomization may have conferredsome advantage to the high-dose group. There is also the possibility that a therapist

may have been more effective with the high-dose group though the high improvementrate of the low-dose group suggests that this is not true. It is also possible that the people

in the hlgh-dose group were able to take more advantage of vocational rehabilitation, etc.

On the other hand, the fact that the low-dose group did as well as it did probably

rcflects the intensive preparation therapy and LSD session which they received. Many

of our 50mcg sessions involved considerable abreaction and catharsis of psycho- tdynamically charged material. The dramatic changes observed in some of our high-dose

sessions suggests that for some patients the high-close procedure is probably most

beneficial, but for a considerable number of other patients the low-dose treatment was

also quite helpful. In retrospect, a control group receiving no LSD would have beenL!

helpful in differentiating the exact role of psychotherapy as opposed to LSD session.In actual practice, however, these two factors, it must be pointed out, are closely inter-

woven and work together as a unified treatment approach.

In the context employed, the psychedelic psychotherapy was successful in helping

over half of the alcoholics treated in this program as opposed to a 12°/0 improvementrate at 18 months follow-up for comparable alcoholics in this treatment facility at SpringGrove State Hospital. This 120/0 factor is from a prior study and does not represent a

concomitant comparison control group. It would also appear that there may be a

correlation between the psychotherapist's skill and its contribution to the meaning-

fulness of the drug experience session. However, this is an issue requiring furtherinvestigation.

Finally, it is our impression that the overall clinical achievements of only one psych-

edelic peak exPerience and its maintenance for a period of several months in these typesof patients is an observation that cannot be discounted. This will require further study

of those factors that may yield additional enhancements that, can intensify and extendthe duration of the therapeutic effect. A variety of approaches should be tried, in-

cluding the use of LSD as an aid to psychotherapy at many different dosage levels.i

Acknowledgements !

These investigations were supported in part by United States Public Health Service research igrants MH-13747, MH-15555 and FR-05546, administered by Friends of Psychiatric Research,Inc., Baltimore, Maryland. Grateful acknowledgement is made to the efforts of Sanford Unger, i

_ii_ Ph.D., Lee McCabe, Ph.D., Sidney Wolf, Ph. D., William Richards, S. T. M., and Harry Shock,

• :_i LL.B. who collaborated in this study.

" Summary

The use of LSD in the treatment of alcoholism has led to many claims concerning the drug'sefficacy. Efforts to verify these reports in controlled studies have been diftieult because of theunique effects of LSD. Despite this formidable methodological obstacle a number of investi-gations have been carried out. A critique of these is presented followed by our own researchexperience in a double-blind, controlled study with 135 chronic alcoholics. In our investigation LSDwas employed only as an adjunct to psychotherapy, and most patients received only one sessionwith LSD. Our method is called psychedelic peak therapy because during the actual administra-

ffentlichen LSD in the Treatment of Alcoholics 93

tion of LSD the aim is to achieve a positively profound and insightful experience, hopefullyyielding beneficial personality and attitudinal changes. Dosage was 450 micrograms for theexperimental group and .50 micrograms or the control group. Both groups were treated withina hospital setting and were followed at 6, 12, and 18 months to assess post-hospital adjustment.The high dose group showed a statistically significant advantage over the low dose group on

n drinking behavior and global adjustment at the end of 6 months, but this initial gain wasattenuated so that by the end of 12 to 18months of follow-up there were no significant differencesbetween the groups, although the overall level of improvement was considerably better for both

I groups than the usual improvement for other alcoholics in the same setting without any form ofLSD-assisted psychotherapy. These results have indicated that further research is needed in orderto discover how to sustain and maximize the initial therapeutic benefits we have observed.

Zusammen[assung

Der Gebrauch yon LSD in der Behandlung des Alkoholismus hat zu vielen Thesen hinsichtlichder Wirksamkeit dieses Stoffes gefiihrt. Bcmfihungen, die Richtigkeit yon Berichten dutch kon-trollierte Studien zu best$,tigen, waren schwierig wegen der einzigartigen Auswirkungen von LSD.Trotz diesem betr_chtlichen methodischen Hindernis sind eine Menge Untersuchungen durch-geffihrt worden. Eine Kritik dieser Untersuchungen wird dargestellt, erg_inzt durch unsere

n eigenen Forschungserfahrungen aus einer Doppelblindkontrolluntcrsuchung an 133 chronischenA!koholikern. Bet unserer Untersuchung wurde LSD nur zus_itzlich zur Psychotherapie verwendet,und die meisten Patienten erhielten nur in einer Sitzung diese Droge. Unsere Methode bezeichnenwir als ,Psychedelic peak therapy": es ist das ZiC wahrend der Verabreichung des LSD, einbestimmtes tiefempfundenes und einsichtsvolles Erlebnis zu erreichen in der Hoffnung, heilsamcVer_nderungen der Pers6nlichkeit und ihrer Haltung zu erzielen. Die Dosis betrug 450 Mikro-gramm bet der Versuchsgruppe und 50 Mikrogramm bet der Kontrollgruppe. Beide Gruppenwurden unter Krankenhausbedingungen behandelt, und in Abst_inden yon 6, 12 und 18 Monatenfolgten kontrollierende Nachuntersuchungen, um die Anpassung nach der ersten Behandlungs-phase absch_tzen zu k6nnen. Die h6her dosierte Gruppe zeigte eine statistisch bedeutsame 13"ber-

:neimittel- legenheit gegenfiber der niedrig dosierten Gruppe im Trinkverhalten und in der Gesamtanpassung

'_Deutsch- nach 6 Monaten. Nach 12 bis 18 Monaten jedoch wurde dieser Anfangserfolg vermindert, so dal_es keine auff_illigen Unterschiede zwischen beiden Gruppen mehr gab, obwobl die Besserung

rlmden. In insgesamt bet beiden Gruppen wesentlich starker war als die fibliche Besserung bet anderen

iegelungen Alkoholikern unter gleichen Bedingungen, allerdings ohne Therapieunterstfitzung durch LSD.Diese Ergebnisse haben unterstrichen, dat_ weitere Forschung notwendig ist, um herauszufinden,

um einen wie man die yon uns beobachteten therapeutischen Anfangsvorteile optimal stiitzen und ver-al]nahmen st_rken kann.

m6glichen. Literatureeine Basis

1 Abramson, H. A.: The Use of LSD in Psychotherapy. 9 ]ohnson, G.: LSD in the treatment of alcoholism.?ll ZU ether Josiah Macy, Jr. Publication, New York 1960 Amer. J. Psychiat. 126 (1969), 4SI

2 Abramson, H. A.: The Use of LSD in Psychotherapy 10 Kurland, A. A., S. Unger, ]. W. Shal[er, C. Savage:_,ebzmg zu and Alcoholism. Bobbs-Merrill Co., New York 1967 Psychedelic therapy utilizing LSD in the treatment

of the alcoholic patient: A preliminary report. Amer.lel.roffenen 3 Ch_,elos, N., D. Ble_,ett. C. Smith, A. Hotter: Use of J. Psychiat. 123 (1967), 1202

LSD in the treatment of alcoholism. Quart. J. Stud. I1 Leuner, H.: in Ahramson, loccit. (1967)$3ensdla_- Alcohol. 20 (1939), 577 12 Ludwig, A., ]. Levine, L. Spark, R. Lazar: The cli-

?setzgeber. 4 Colby, K. M.: Psychotherapeutic processes. Ann. Rev. nical study of LSD treatment in alcoholism. Amer. J.• Psydaol. 15 (1964), 347 Psychiat. 126 (1969), 59

mmenstel- 5 Hicks, R. E., P. V. Fink: Psychedelic Drugs. Grune 13 Osmond, H.: A review of the clinical effects of psy-& Stratton, New York 1969 dlotomimetic agents. Ann. N. Y. Acad. Sci. 66 (1957),

418

usgearbei- 6 HoIIer, A.: in Abramson, loc. eit. (1960) 14 Pahnke, W. N., W. A. Ridmrds: Implications of LSDetzgebung 7 Holler, A.: in Abramson, loc. cit. (1967) and experimental mysticism. J. Relig. Hlth 5 (1966),

aus ihrer s Hollister, L. E., ]. Shelton, G. Krieger: A controlled 175comparison of lysergic acid diethylamide (LSD) and 15 Pahnke, _4r. N., A. A. Kurland, S. Unger, C. Savage,dextroamphetamine in alcoholics. Amer. J. Psychiat. S. Gro[: The experimental use of psychedelic (I,SD)125 (1969), 58 psychotherapy. J. Amer. med. Ass. 212 (1970), 1836

94 O. Benkert, H. Beckmann i

16 Salzman. C.: Controlled therapy research with psy- 19 Smart, R. G., T. Storm, L. Solursh, E. F. W. Baker: 1

daedelic drugs. In }licks, loc. cir. (1969) Lysergie Acid Diethylamide (LSD) in the Treatment

17 Savage, C.: in Abramson, loc. eit. (1960) of Alcoholism. University of Toronto Press, Toronto !iS Schlien, ]. M., H. F. Hunt, ]. P. Matarazzo, C. Savage: 1967 ._

Research in Psychotherapy. American Psychological 20 Smith, C. B.: A new adjunct to the treatment of al- Wl'.

Association, Washington, D. C. 1968 coholism: The hallucinogenic drugs. Quart. J. Stud.Alcohol. 19 (1938), 406 ot}

3"}Albert A. Kurland, M.D., Maryland Psyd, iatric Resear& Center, P.O. Box 3235,

Baltimore, Maryland 21228, U.S.A. pa

pLt

DisuifiramEffect on Depressionand Paranoid Score, p]!5-hydroxyindoleacetic Acid and Vanillylmandelic _rlAcid Excretion in Urine v:

aIL

O. Benkert, H. Beckmann Tt:Ill

Max-Planck-lnstitut for Psychiatrie, Neurochemische Abteilung, Miinchen cr(

i

The alcohol sensitizing effect of disulfiram (tetraethylthiuram disulfide, Antabus) iswell known, even though the exact cause for this effect is not yet clarified (]acobsen 17i.

1967). Only after Goldstein et al. (1964) had established disulfiram influence upon "tcatecholamine (CA) metabolism, was more interest shown towards this substance. In andanimal experiment it is possible to solely reduce norepinephrine (NE) brain level without (I_also reducing dopamine (DA) brain level (Goldstein and Nakajima 1967). itsc

Reserpine (Harris 1957) and a-methyl-dopa (Gillespie et al. 1962), which can reduceNE and DA as well, can bring about a depressive symptomatic upon humans. These Ta_,and many other observations upon humans and animal experimental results led to the 14 ,

NE hypothesis of depression, where a NE metabolism disturbance in the central nervous si_,_system (CNS) could be assumed (Bunney and Davis 1965, Schildkraut 1965, Matussek1966).

Does disulfiram produce similar psychic changes like reserpine and ct-methyl-dopa?Also with small dosages of disulfiram and also without the alcohol-disulfiram-reaction

it came to various psychotic behaviour changes. A majority of these disulfiram psychosis D,consists of paranoid or depressive reactions (review of literature: Angst 1956, Liddonand Satran 1967). These clinical observations on the one hand and the NE brain leveldecrease after disulfiram in animal experiments on the other hand, caused us to check tbthe effect of disulfiram upon the depressive and paranoid score. We had undertaken ththese examinations upon alcoholics which had anyhow received disulfiram, rather than inupon volunteers, because of the possible disulfiram side effects. Furthermore it seemed si:important to us to determine 5-hydroxyindoleacetic acid (5-HIAA) urine excretion ncduring disulfiram treatment as disulfiram is assumed to influence 5-hydroxytryptamine fir(5-HT) metabolism (Feldstein and H/illiamson 1968). The vanillylmandelic acid (VMA)urine excretion was also measured to see whether or not the given disulfiram dosage had di

the expected influence upon CA metabolism• A